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2. First Name
3. Last Name
5. Address
7. City, State, Zip
9. Optional

   Add your email and/or phone number if you would like someone to contact you to follow up.

11. Email
12. Phone Number

14. If you smell natural gas, call 9-1-1. For all other odor complaints, continue to complete the information below.

16. Description of Odor*
    -- Select One --Burnt SmellChemical SmellDog FoodExhaustGarbageGreaseManurePaintRotten EggsSmokeSourYard WasteOther

    In describing the odor, please choose from the list of odor descriptors and select the one you believe most closely resembles the odor you are smelling.

18. Other Odor

    If you selected "other" from the listing above, plesae describe, as best you can, the odor.

20. Location of Odor*

    Please list the location the odor was detected (i.e. at the corner of 1st St. and 2nd St.; directly in front of building XYZ on 1st St.; etc.)

22. Strength of Odor*
    -- Select One --1 - very weak2345678910 = very strong

    Rate the strength of the odor on a scale of 1 to 10 (1 = very week, 10 = very strong)

24. Additional documents or information you want to submit regarding the odor.
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field